Heart disease is the leading cause of death among elderly American Indians and Alaska Natives. Heart disease death rates for elderly American Indians, at 157.1 per 100,000, are 20 percent higher than average in the total U.S. population. Most elderly Native Americans live in remote locations and lack transportation to healthcare facilities. This is a key barrier that complicates healthcare access and prevents adequate long term monitoring of coronary artery diseases (CAD). Access to a facility that can perform a cardiac stress test is particularly difficult. The elderly patient often has to travel several hour for such testing because the small clinics located on a reservation are typically staffed by a doctor and a small number of technicians. Often, these small clinics do not have a staff member with the training, experience, and procedural skills to administer a cardiac stress test. Cardiac testin has been used in clinical practice for many years and its use has contributed significantly to the management of many patients. In its current form, clinical exercise testing consists of the continuous monitoring of an ECG (12-lead system) with frequent recordings of 12-lead tracings. Additional tracings are taken according to clinical circumstances. Frequent blood pressure determinations are made before, during, and after exercise of progressively increasing intensity (usually with a treadmill) to any of a number of test end points. This project proposes to develop a telemedicine system that will allow a reservation clinic staff member to administer a cardiac stress test under the interactive supervision of a person experienced in cardiac stress testing protocols. Preliminary data will be collected on acceptance, usability, and utility of the proposed Telemedicine Cardiac Stress Test System through focus groups. The focus groups will consist of Native American patients, primary care physicians, nurses on a reservation, and personnel responsible for performing cardiac stress tests. Human trials with American Indians living on reservations will be completed in Phase II.